Monday, October 25, 2010

Day 1

Thank you all for your questions and requests for EB Awareness Week. I will try to answer them all, but today I wanted to start with some of the "basic" EB questions. WARNING: I am no where near an EB specialist- my information is coming from what I read online and from my own personal experience. I do not intend to offend anyone, so I apologize in advance if I do so.

First, I want to just give a quick summary and "definition" of Epidermolysis Bullosa... for my newcomers :)

EB is a rare, genetic skin disease that involves the connective tissues of your skin. Even the slightest bit of friction to the skin can cause severe blistering, both inside and outside of the body. Individuals with EB are usually refered to as "Butterfly Children" because their skin is as fragile as the wings of a butterfly. There is currently no cure for EB, and the only treatment is supportive care such as wound care and bandaging (or in Tripp's case: wound care, bandaging, eyes, trach, feeding tube, etc...) Severe forms of EB often lead to constant pain and scarring; or in some cases death. I like to use the analogy that I got from the dermotologist in Cinncinati- In EB, the top layer of skin is the grass, and the bottom layer is the soil- but you are missing the "roots" that hold the skin together.

So here are a few of your questions:

For your EB awareness week, I would like to know if they know what causes EB, since I know nothing about it.

In most cases, EB is inherited. Research has found that there are close to 10 genes involved with the skin formation that can be mutated and cause EB. But in addition to EB being inherited, it can also be caused by a spontaneous mutation. There are 3 main types of EB: Simplex, Junctional, and Dystrophic. In simplex, most cases are inherited by a dominent gene mutation (one parent carries the mutation).

Junctional EB, can ONLY be inherited by 2 recessive mutations from each parent, which is what happened in Tripp’s case. Randy and I both carry the recessive gene mutation.

Dystrophic EB can be inherited by either dominent OR recessive mutations.

Tripp has Junctional EB. We were told he is 1 in 2 million. His type is divided into 2 subtypes: Herlitz and non-Herlitz. Tripp’s biopsies to further diagnose him were inconclusive, and we never went any further. There have been both Herlitz and non-Herlitz babies that have not made it. What was the point in further testing? Maybe one day when we don't have so many other things to worry about :)

I would love to know more about the different types of EB and how they affect the person differently. I hear (see? read? haha) the terms JEB and RDEB alot and have tried to research it some just to know, but I get lost in the medical terminology. SO - I thought you might be able to put it into *plain english* for us!

So first of all, I want to explain the “layers of skin” to you- in very “laymen” terms. I’ll describe them as if they were a flowerbed. There are 3 layers of your skin. Epidermis, Dermis, and Subcutaneous.

-Epidermis (mulch over a flowerbed): this layer is the very top thin layer that protects you from injury and organisms. It holds in fluid and protects your raw nerves from too much stimulation.

-Dermis (the top soil): this is where things grow. Hair follicles, sweat glands, nerve cells. If this layer gets damaged, it will drain a serous (clear) fluid and start to swell.

-Subcutaneous (the sandy foundation) this layer is not really skin, but attatches everything to the very bottom. The blood vessels in this layer feed the dermis (above it). (Insert Picture)

So now, there are 3 main types of inherited EB- Simplex, Junctional, and Dystrophic.

EB Simplex is most often dominantly inherited. It involves the uppermost layer of skin (within the epidermis) There is little internal involvement of blisters, except in the mouth- usually at a young age. The blisters usually affect the palms and soles of the hand and feet. And they often develop thickened fingernails shortly after birth.

Junctional EB is always recessively inherited. It involves the layers between the epidermis and dermis- depending on the different types. There are 2 main subtypes of Junctional EB: Herlitz and non-Herlitz.

-Junctional Herlitz is a very severe type of EB. Death usually occurs by the second year of life- do to infection, malnutrition, dehydration, electrolyte imbalance, organ failure due to internal blistering, etc. Blistering may be present at birth, but most times the blisters come gradually and usually affect every part of the body, including the mucous membranes.

-In non-Herlitz Junctional EB, blistering may be mild to severe, and also involve all the parts of the body, including the insides. Death may or may not occur from the same complications listed above.

Dystrophic EB can be inherited either by either a dominant or recessive gene. Blistering can be involved in the subcutaneous layer of skin or between the epidermis and dermis layers. And these blisters most time result in scarring and webbing of the hands and feet. There are two main types of Dystrophic EB: Dominant Dystrophic (DDEB) and Recessive Dystrophic (RDED).

-In Dominant Dystrophic, the blisters are usually limited to the hands, feet, knees, and elbows. However it can involve mucous membrane involvment and abnormal or absent fingernails.

-Recessive Dystrophic EB is typically more severe than DDEB, and in addition to what is listed above, there is also malnutrition, dehydration, webbing and fusing of the fingers and toes, internal organ involvement, esophogeal strictures, etc. The risk of skin cancer is increased for this type of EB and can sometimes result in death.

These are the MAIN types and subtypes. I know I am leaving out some other subtypes, but there is A LOT of detail and I didn’t want to lose you.

One thing I would like to know more about is the genetics of EB. I am a nurse so all this stuff is of interest to me

So, this genetic stuff is WAY over my head. But I will try to give a basic summary. Like I said above, there are three ways you can get EB: Autosomal Dominant Inheritance, Autosomal Recessive Inheritance, or a spontaneous mutation.

Autosomal Dominant Inheritance: this is where each gene for the condition expresses itself in an individual. A parent with an autosomal dominant form of EB has a 50/50 chance with each pregnancy of transmitting the abnormal gene. A child who does not inherit the gene for EB from that affected parent will not have the condition and cannot pass it on to future generations.

Autosomal Recessive Inheritance: this is where a recessive gene for the disorder is passed from each parent and the two genes are paired together, causing the disorder to be passed along to the child. If a person has one recessive EB gene paired with a normal gene, the person is “a carrier", but does not have the disorder. If parents are each both carriers of an autosomal recessive gene, there is a 25 percent chance with each pregnancy that their children will have the disorder. A person with a recessive form of EB will be at risk of having an affected child only if he or she reproduces with a carrier or another person with the recessive form of EB.

Spontaneous Mutation: In some cases, neither parent has EB, but the couple has a child with an autosomal dominant form of EB. In this situation, the condition has usually been caused by a change, or mutation in the genetic material of the egg or the sperm. When a new mutation occurs, the affected individual will have a 50/50 risk of passing the mutation on in future pregnancies, but his/her parents will not.

This is a very generic explanation, but I don't think it's possible for me to explain each mutation and where they are located... So I'm giving you a picture from DebRA.org :)

Image used with permission from eMedicine.com, 2008

There are an estimated 1 in every 50,000 people in the U.S. that are born with some type of EB.

Tripp’s type- Junctional, is estimated at about 1 in every 2 million people.

10 comments:

I've visisted this blog a few times and it brings me such joy knowing that you and your husband are persevering through all of this together! AFter reading just one article, I know that I, myself, would never be strong enough to face this day by day, that I would just break down because of helplessness. I know it has to be tough for the two of you, but in all that you've been through, do you think you'll ever want to have any more children?

Great job Courtney~ You make it very clear, your knowledge is great! My daughter Bridget also opted out of some testing to "determine" certain facts in regards to her son's OI. Why put the baby thru more than what he is already enduring. I am hoping you little man is feeling a little better today! Thank you for making us AWARE!

Hey Courtney! You ROCK at explanations!! Thank you for going to that much effort for us...as if you don't have enough to do caring for Tripp! You answered my question and did a great job of putting into "plain English" for me!!

Courtney, I just want to commend you on your posts. I have a very hard time trying to understand the medical language I have been reading online regarding EB. You did a great job breaking it down. Also, I liked the mulch, soil, sandy foundation analogy. I was able to visualize that one. Thanks again for sharing your little man with all of us. -Sharee

Hi Courtney: Thank you so much for this posting. You did a great job of describing this awful disease. Awareness of this awful disease is really the key for hopefully finding a cure. We had never heard of it before Leah was born and sorry to say we know too much now.Thanks again and give that precious son of yours a big hug and kiss for me. Love you guys. Love and Peace Leah's Nana

Very good answers to a very difficult (gah!) to understand condition. I know you are answering questions lately and you may already have this one or whatever but I just wonder: When Tripp goes to school (elementary, etc) what steps do schools take to ensure EB kids are ok during the school day? And I know that is far off from where you are but I didn't know if you had thought about school days yet:)

Again, you are an awesome mom, Courtney! I say that every time; and mean it each and every time too!